Hepatitis E

Synonyms in the broadest sense

inflammation of the liver, inflammation of liver parenchyma, viral hepatitis, autoimmune hepatitis, toxic hepatitis

Definition

Hepatitis E is caused by the hepatitis E virus (HEV). This virus is an RNA virus, which means that it has stored its genetic information as RNA. Hepatitis E can be accompanied by fever, skin rash, jaundice (icterus), abdominal pain (especially in the right upper abdomen), nausea, vomiting or diarrhoea.

It is also possible that a hepatitis E infection may have no symptoms at all, but the infected person is still contagious to others. The virus occurs worldwide. In Germany, genotype 3 of the HEV is mainly present. Domestic pigs and wild boars are seen as the so-called reservoir for the virus, whereby the virus can be transmitted by food that is not completely cooked through. The number of annual infections with hepatitis E is also increasing again.

Symptoms of hepatitis E infection

After infection it takes 15-64 days until the disease breaks out (incubation period). Hepatitis E does not differ from hepatitis A in its symptoms. The majority of childhood infections do not cause any symptoms at all, but HEV infections hardly ever occur in patients under 20 years of age.

In the so-called prodromal stage, which lasts 2-7 days, flu-like symptoms such as

  • Increased temperature and
  • Exhaustion, also kicking
  • Nausea,
  • Loss of appetite,
  • Pressure pain in the right upper abdomen and
  • Possibly diarrhea. Further symptoms are acutely occurring
  • Skin rash and
  • Joint pain, which does not always occur.

In the second stage (duration 4-8 weeks) the virus settles in the liver. Adults now show jaundice (icterus).

In addition to the discoloration of the white dermis in the eye, and subsequently of the entire body surface, this liver manifestation manifests itself in a darkening of the urine with simultaneous decoloration of the stool. The liver is now clearly enlarged and painful. In about 10-20% of cases, an enlargement of the spleen and swelling of the lymph nodes can also be observed at this stage.

In 3% of HEV-infected persons (in pregnant women up to 20%) a so-called fulminant hepatitis E with three classical symptoms (triad) develops. Jaundice (icterus), coagulation disorder and impaired consciousness. Here, the liver damage is so severe that the liver is no longer able to form clotting factors and break down the blood pigment, which is then deposited in the skin above a certain concentration, causing it to turn yellowish.

The fulminant hepatitis E thus leads to complete liver failure. In contrast to the other forms of hepatitis, no chronic courses of hepatitis E have been described so far. Chronic hepatitis is defined as an inflammation of the liver that is not cured after six months. Possible consequences of chronic hepatitis are a connective tissue remodelling of the liver (liver cirrhosis) and a so-called hepatocellular carcinoma (HCC), i.e. liver cancer.